Septic shock (Part 2).
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Aminoglycosides↗
Biomedical subjects
R Berringer
Publications and source records attributed to R Berringer.
Septic shock (Part 1).
Septic shock is a distinct clinical entity with an overall mortality of 30% to 40%. Gram-negative organisms are the most frequently identified causal agents. The shock syndrome appears to result from activation of complement, coagulation, kinin, endorphin, and other hormonal systems. Physiologic abnormalities include hypotension, metabolic acidosis, increased cardiac index, and decreased tissue extraction of oxygen. Clinicians must entertain the diagnosis of septic shock in a variety of settings, as prognosis is affected by early institution of therapy. Treatment is directed toward control of infection with antibiotics and surgical drainage and cardiorespiratory support utilizing fluids and pressor agents. Future therapeutic options may include naloxone, cyclooxygenase inhibitors, and antiserum to endotoxin.
Adenosine Triphosphate↗
Outcomes of a community pharmacy-based diabetes monitoring program.
PRIMARY OBJECTIVE: Evaluate the effects of a point-of-dispensing (POD) pharmaceutical care model on outcomes of self-monitored blood glucose (SMBG) results, SMBG frequency, and medication adherence rates for patients with diabetes. SECONDARY OBJECTIVE: Measure the rate at which physicians implemented therapy recommendations made by community pharmacists. DESIGN: 12-month, noncrossover, single-group trial. SETTING: Two independent community pharmacies in Richmond, Va. PATIENTS: 101 patients were initially identified as potential participants; of the 82 that elected to participate in the study, 62 (76%) completed the first 6 months and 52 (63%) completed the entire 12-month study period. INTERVENTION: This pharmaceutical care program was integrated into the dispensing function: subjective and objective data related to diabetes care were gathered with each prescription refill. Recommendations were made to patients and their physicians. MAIN OUTCOME MEASURES: SMBG values and frequency at baseline, 6, and 12 months. Diabetic medication adherence rates for 1 year before and during participation were evaluated. Community pharmacist recommendations and implementation status were followed over the 12-month period. RESULTS: Average morning blood glucose values (n = 27) decreased from 178.6 mg/dL to 159.3 mg/dL, from baseline to 6 months, respectively (p = .07). Blood glucose values (n = 23) at baseline and 12 months decreased from 179.0 mg/dL to 149.7 mg/dL, respectively (p < .05). There was no statistical difference in SMBG frequency. A diabetes medication adherence rate of 90% was maintained over the 12-month study period. Physicians implemented 15 of 20 (75%) recommendations. CONCLUSION: This model offers an effective and efficient mechanism for providing pharmaceutical care for patients with diabetes.
Adult↗